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General NPI Number Information
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NPI Number | 1205878790
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Entity Type | Individual
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Provider Name | PRATHEEP PAWA MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 125 CANTON RD NW
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City | CARROLLTON
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State | OH
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Zip | 44615-1009
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Country | US
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Telephone | 330-627-7641
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Fax | 330-627-5796
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Provider Business Mailing Address
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Address Line | 1320 MERCY DR NW SECOND FLOOR MERCY HALL
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City | CANTON
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State | OH
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Zip | 44708-2614
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Country | US
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Telephone | 330-471-5930
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Fax | 330-471-5938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 35085326
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35085326
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License Number State | OH
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